title: Maternal use of cyclobenzaprine (Flexeril) may induce ductal closure and persistent pulmonary hypertension in neonates.
abstract: A full-term male infant presented shortly after birth with respiratory distress. An echocardiogram done within the first hour of life showed an elevated pulmonary artery pressure, an associated right ventricular hypertrophy without a patent ductus arteriosus. The patient was treated for persistent pulmonary hypertension with favorable response. Maternal history was unremarkable except for chronic low back pain treated with cyclobenzaprine (Flexeril®). A proposed mechanism for cyclobenzaprine includes inhibition of norepinephrine and serotonin reuptake, factors known to inhibit prostaglandin and nitric oxide. These two factors are the leading causes of in-utero ductal closure. This report is the first to indicate that cyclobenzaprine use during late pregnancy should be considered a potential cause of early ductal closure.
authors.affiliation: Department of Pediatrics, University of Texas Health Science Center-San Antonio , San Antonio, TX , USA and.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Moreira
authors.forename: Clay
authors.initials: C
authors.lastname: Barbin
authors.forename: Hugo
authors.initials: H
authors.lastname: Martinez
authors.forename: Ashraf
authors.initials: A
authors.lastname: Aly
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000000981:diagnostic imaging; D000639:Amitriptyline / Q000009:adverse effects / Q000031:analogs & derivatives*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D004373:Ductus Arteriosus / Q000187:drug effects / Q000473:pathology*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000139:chemically induced / Q000000981:diagnostic imaging; D006345:Heart Septal Defects, Ventricular / Q000139:chemically induced / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects*; D010547:Persistent Fetal Circulation Syndrome / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011247:Pregnancy; D014463:Ultrasonography
chemical_list: D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline; C004704:cyclobenzaprine
keywords: Cyclobenzaprine; ductus arteriosus; neonate; persistent pulmonary hypertension